Defending against Infectious Diseases & Biological Threats

Transcription

1 Defending against Infectious Diseases & Biological Threats Dr Henk Bekedam WHO Representative, China 21 st September

2 Presentation Summary 1. Lessons learning from SARS and Avian Influenza 2. Current Biological Threats 3. How best can we prepare? Detection Response and getting prepared Prevention remains the best Communication 4. WHO s role in this respect 2

3 Lessons Learning An infectious disease in one country is a threat to others The best chance to eradicate or contain a new or a reemerging disease is when it surfaces Early reporting, sharing of information and virus samples within countries and with the international community is key to timely response Containing emerging diseases requires government commitment and international collaboration 3

4 Lessons Learning 75% of emerging diseases are zoonotic. Cooperation between Health, Agriculture and Forest administrations responsible for domestic and wild animals is crucial Market failures in public health. Governments need to take greater responsibility in the defence against infectious diseases and biological threats: Awareness Surveillance Bio-safety and hospital infection control Treatment of infectious diseases 4

5 Current biological threats (5x) 1. Avian Influenza Since December 2003: 112 cases; 57 deaths Epidemiological changes: North Vietnam Human cases identified in more countries: Thailand, Vietnam, Cambodia, and Indonesia H5N1 in wild birds and poultry geographical spread to Mongolia, Kazakhstan, Russia, Europe 5

6 6

7 .. Avian Influenza Turning to China: No human cases reported so far 4 outbreaks in migratory birds previously resilient and domestic poultry : Qinghai, Xinjiang (2), and Tibet; China has approximately 14 billion domestic birds, of which 70-80% being kept in backyard farming H5N1 virus circulating since 1996 Poultry vaccination standardized for 20% of poultry CONCLUSION: H5N1 widely spread H5N1 remains a formidable threat unstable, versatile and unpredictable virus 7

8 Current biological threats 2. Current & emerging and re-emerging diseases Global challenges for AIDS, Tuberculosis, Malaria, and many others On average, one new human disease per year, of which 75% is from animal origin Diseases can re-emerge after containment if the reservoir of the virus still exists Ebola re-emerged after five years SARS still reservoir in wild animals. More detailed animal research is needed to improve the defense mechanisms for SARS to re-emerge Streptococcus Suis 8

9 Emerging and re-emerging zoonoses Ebola and CCHF Influenza H5N1 Hantavirus Lassa fever Monkeypox Nipah Hendra vcjd Rift Valley Fever SARS-CoV VEE Yellow fever West Nile Brucellosis Cryptospporidiosis Leptospirossis Lyme Borreliosis E Coli O157 Multidrug resistant Salmonella Plague 9 3

10 Current biological threats 3. Bio-safety lapses 11 out of 15 SARS cases after 2003 major outbreak, were linked to bio-safety lapses in 3 separate laboratories In 2004 bio-safety lapses occurred with Ebola and inadequately inactivated anthrax in different countries with some deadly consequences Recent mailing of H2N2, a strain that killed 4 million people in 1957, to 5,000 labs in 18 countries showed the vulnerability of current global practices 10

11 Current biological threats 4. Bio-terrorism Anthrax in 2001 in the US reminded us that infectious diseases can also deliberately be introduced into society 5. Multi-drug Resistance (MDR) Viruses and bacteria develop resistance to medication, when inappropriately taken (over-, under-, and misuse) MDR viruses and bacteria pose great challenge not only to countries where they have been created, but also to countries they will travel to 11

12 How best can we prepare? Considerably large and variable threats, but fortunately, the answers have a common approach Building capacity to improve system of detection, response and communication Preparing for a pandemic Sharing of information and virus when disease outbreak strikes Preventing diseases from becoming a threat to humans 12

13 How best can we prepare? What is needed is an increased global capacity. The system is as strong as the weakest link in the chain and there is a clear need for countries to effectively help each other. Disease outbreaks have a negative economic impact on tourism, travel and trade Disincentive for reporting Need for risk communication Need for Global Fund? Building trust is important 13

14 How best can we prepare? 1. Detection Human and animal surveillance: Detection of diseases in animals to be strengthened. Identifying human cases, like in AI, will heavily rely on detecting the disease in animals Setting up drug resistance surveillance for bacteria and viruses Laboratory diagnostics networks within countries and with the international community Sharing of information and virus remain key in timely response (SARS corona virus identified in 6 weeks using the global laboratory network) 14

15 How best can we prepare? 2. Response (1) Pre-pandemic planning Absentism in essential services like transport, food, and security will disrupt our daily lives Define roles & responsibilities for National and International authorities, WHO, FAO, OIE, other UN agencies, and others (2) Drug development Innovative and new drug development crucial in dealing with MDR and finding treatments for emerging diseases 15

16 .. response (3) Anti-virals stockpiling for those who can afford Stockpiles and guidelines for antiviral distribution and use Availability of antivirals for developing countries is unrealistic as supplies are limited and costs are high creating a tension between the haves and the have-nots (4) Pandemic vaccine production Advising national authorities to facilitate licensing and registration requirements and vaccine production Encouraging investment into pandemic vaccine research now to reduce time lag between emergence of pandemic strain Again tension to be expected due to limited production capacity 16

17 How best can we prepare? 3. Prevention remains the best (1) Animal and Human Interaction Animal husbandry living safe with animals Animals (ducks, chickens, pigs, etc.) to be separated to avoid cross-infection; realistic in poverty stricken areas? Nets over farming areas would protect domestic poultry from being infected by wild waterfowl Challenge of regulating or abolishing wet markets; can it be done? 17

18 prevention remains the best (2) Bio-safety & bio-security are crucial in containment of emerging diseases (3) Food safety and occupational health safety Well cooked food generally safe AI: poultry holders, butchers, farmers, children,. SARS: wild life traders, preparing wild-life delicatessen, health care workers, and staff working in laboratory Streptococcus Suis: butchers and farmers Environmental factors? 18

19 How best can we prepare? 4. Communication Must be part of any outbreak response at early stage Make people aware of what to do and what not to do Important to guide the population: Don t create panic and unnecessarily fear BUT : Communicating what constitutes a public health threat is difficult and journalists are generally much better in spreading the scary news than the re-assuring messages 19

20 World Health Organization s s Role International Health Regulation (IHR) ensure maximum protection of people against international spread of diseases, while minimizing interference with world travel and trade The new IHR enters force in June 2007 Member states are obliged to: Notify WHO for a single case of any new or re-emerging disease considered a public health emergency of international concern, incl. any chemical or biological concerns of public health threat Respond to requests for verification of information Respond to public health risks which may spread internationally Develop, strengthen and maintain the capacity to detect, report and respond to public health events 20

21 International Health Regulation Under IHR, World Health Organization is obliged to Conduct daily global surveillance of international intelligence to detect possible risks of public health emergency of international concern for verification with member states Determine whether or not a particular event notified by a state constitutes a public health emergency of international concern Provide technical assistance to member states in their response Develop and recommend measures to member states for use during public health emergencies, based on a consistent process of risk verification and assessment 21

22 WHO s s Role Capacity building & technical assistance to member state Global Outbreak Alert and Response Network (GOARN) During outbreaks, experts from throughout the world can immediately be mobilized to rapidly identify, confirm the cause, combat and respond to outbreaks GOARN ensures that appropriate technical assistance reaches affected areas rapidly GOARN also contributes to long term epidemic preparedness and capacity building 22

23 In Closing The system is as strong as the weakest link: It requires government investment and countries need to support each other Inter-sectoral & International Collaboration key to containment WHO can play a facilitating and supporting role following the IHR Prepare while you can: it is worth the investment We cannot prevent an Avian influenza as we cannot prevent a Tsunami or a Katrina, but we need to be better prepared to deal with the consequences 23

24 Thank you 24